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The Best Care Possible: A Physician's Quest to Transform Care Through the End of Life [Englisch] [Gebundene Ausgabe]

Ira Byock MD

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15. März 2012

A palliative care doctor on the front lines of hospital care illuminates one of the most important and controversial ethical issues of our time on his quest to transform care through the end of life.

It is harder to die in this country than ever before. Statistics show that the vast majority of Americans would prefer to die at home, yet many of us spend our last days fearful and in pain in a healthcare system ruled by high-tech procedures and a philosophy to "fight disease and illness at all cost."

Dr. Ira Byock, one of the foremost palliative-care physicians in the country, argues that end-of-life care is among the biggest national crises facing us today. In addressing the crisis, politics has trumped reason. Dr. Byock explains that to ensure the best possible care for those we love-and eventually ourselves- we must not only remake our healthcare system, we must also move past our cultural aversion to talking about death and acknowledge the fact of mortality once and for all.

Dr. Byock describes what palliative care really is, and-with a doctor's compassion and insight-puts a human face on the issues by telling richly moving, heart-wrenching, and uplifting stories of real people during the most difficult moments in their lives. Byock takes us inside his busy, cutting-edge academic medical center to show what the best care at the end of life can look like and how doctors and nurses can profoundly shape the way families experience loss.

Like books by Atul Gawande and Jerome Groopman, The Best Care Possible is a compelling meditation on medicine and ethics told through page-turning, life or death medical drama. It is passionate and timely, and it has the power to lead a new kind of national conversation.

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“There is no palliative care physician for whom I have more respect and admiration than Ira Byock. In this strikingly important book, Byock presents an agenda for end-of-life care that should serve as an ideal template on which to build our best hopes for the final days of those we love and ourselves—and a corrective for our society.” –Sherwin B. Nuland, MD, Yale Interdisciplinary Center for Bioethics and author of How We Die

"With elegance, compassion, and energy, Ira Byock shows us how to get the best end of life care. He is a great storyteller and a brilliant analyst of health care in America. This is the book to read or give, if you are facing this hard situation. Nobody gets out of this life alive, but Byock shows us how to do it elegantly and well."
(-Jane Isay, author of Walking on Eggshells)

"This is an extraordinary and wise book on how dying people can be cared for. Written by a master clinician, a man of great compassion, Ira Byock has a vision of health care that is brilliant and kind."  -Roshi Joan Halifax, Abbot, Upaya Zen Center, Sante Fe, author of Being with Dying

"In a world in which politics are polarized and ethical discussions often descend into a food fight, Ira Byock is that rare doctor: a humane guide leading us with honesty and compassion through complex stories about living and dying well. He's a real-life rebuke to those who think palliative doctors are "death panels" and a mentor to every medical student inevitably faced with mortality. This is must reading for everyone trying to make humane decisions in a high tech world." - Ellen Goodman, longtime syndicated columnist for The Boston Globe

“At a time when a long life can become a curse as readily as a blessing, this lucid and compassionate book points the way to more humane treatment of a life’s last days.” –Rabbi Harold Kushner, author of When Bad Things Happen to Good People

“The baby boom generation has transformed every stage of live we’ve touched. We’re now transforming the dying process. And Dr. Byock is leading the way… brilliantly!” – Christiane Northrup, MD, ob/gyn and author of the New York Times bestselling Women’s Bodies, Women’s Wisdom and The Wisdom of Menopause

"A magnificent, moving, and deeply important work. Ira Byock is a trailblazer whose life’s work has forever changed the way we view dying in this country. But there’s much more to be done. The Best Care Possible is Byock’s urgent and passionate call to action for the nation. This book is a must-read for anyone who thinks there’s even a possibility that they someday might die.” –Dave Isay, founder of StoryCorps, author-editor of Listening Is an Act of Love

“In a world of sound bites, end-of-life concerns are framed politically with emotionally charged rhetoric. Above the clamor, Dr. Byock writes a compelling case for consistent, compassionate, and enduring palliative care for all people as they reach the winter of their lives. Through vignettes he outlines the challenges for the patient, the caregivers, and the medical community, and ably advocates a revolution of care for the end of life. This is a revolution sorely needed and worth fighting for.” –Pastor Robert Fleischmann, National Director, Christian Life Resources

“Dr. Byock, one of the country’s leading experts in palliative care, shares his wisdom and insights on how to get the best care possible when we are confronted with a potentially life-limiting illness.  When my own mother was seriously ill, Ira’s words helped our family make the right choices and make sure she got the care she wanted – and no more – during her last months. His words can help you.” --Elliott S. Fisher, MD, MPH, Director of Population Health and Policy, The Dartmouth Institute

“In The Best Care Possible, Ira Byock tells us why we need to move beyond medicine’s fixation on conquering death to a vision of end-of-life care focused on the quality of the patient’s experience.  This is a beautifully written, highly personal account that makes real the struggle of patients and families to escape the “high-tech”, more is better imperative that dominates the American way of death. It provides compelling examples of how the physician, committed to reform, can help patients achieve the care they want and need.  But Byock goes further: he makes the case that professional reform is only part of the solution; overcoming the medicalization of death will require the mobilization of the wider community in the support of the dying (and those with chronic illness).”--Jack Wennberg, MD author of Tracking Medicine: a Researcher’s Quest to Understand Health Care

“This is a profoundly truthful book. Ira Byock uses powerful stories about real people to explain the complications, nuances and often absurdity of advanced illness in 21st century America. He shows how courage, shared decisions, wise doctors and nurses and palliative care can make the difference. Above all, he calls for a cultural transformation, so we can deal with the end of life as individuals, families and society. Who should read it? All of us who are mortal.” -- Bill Novelli, Professor, Georgetown University and co-chair, the Coalition to Transform Advanced Care (and former CEO, AARP)

“Dr. Byock lets the stories of patients, families, and medical colleagues open windows into the heart of the issues. He leads the reader captivatingly from story to story to see and feel what the best care through the end of life can be and deftly invites our nation to envision the best care for our culturally diverse society and cultures. Dr. Byock captures the fundamental human impulse to care lovingly for one another at the most sacred and privileged moments of our lives…now and through the end of life.”-- David Lichter, D.Min., Executive Director, National Association of Catholic Chaplains

“Dr. Byock’s book rejuvenates me. In allowing us the special privilege of entering the sacred space of their final journey, people teach us precious lessons about ourselves. Dr. Byock has a gift of sharing the lessons he’s learned in a most readable narrative marked by compassion, love of life, and lucidity.” -- Rabbi Bunny Freedman, Founding Director of Jewish Hospice & Chaplaincy Network

“There is no palliative care physician for whom I have more respect and admiration than Ira Byock. In this strikingly important book, he presents an agenda for end-of-life care that should serve as an ideal template on which to build our best hopes for the final days of those we love and of ourselves --- and a corrective for our society.”—Sherwin B. Nuland MD Yale Interdisciplinary Center for Bioethics; author of How We Die.

Über den Autor und weitere Mitwirkende

Ira Byock, MD is a practicing physician. He is Director of Palliative Medicine at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire and  Professor at Dartmouth Medical School. Dr. Byock has written widely on the ethics and practice of palliative care and health care systems change. He is a consistent advocate for the voice and rights of patients and their families.

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Die hilfreichsten Kundenrezensionen auf (beta) 4.6 von 5 Sternen  41 Rezensionen
53 von 53 Kunden fanden die folgende Rezension hilfreich
5.0 von 5 Sternen discussion of a critical issue which cannot be avoided 20. März 2012
Von duditos - Veröffentlicht auf
Format:Gebundene Ausgabe|Von Amazon bestätigter Kauf
This book is not intended for everyone. Just for those of us with an ailing loved one, or a loved one who who is dying. Or those of us who may at some time have an ailing loved one, or a loved one who may die. Or those of us who may at some time ourselves be ailing or dying. Dr Byock transforms the discussion of how we live our final days from a political hot potato to a rational, personal and heartfelt fact of life. As a physician, I am keenly aware of the miraculous medical tools that we as Americans are fortunate to have available to us. I am equally aware, however how the inappropriate use of these tools can contradict our ultimate responsibility as physicians to "above all do no harm". More importantly, as the son of one of the patients whose journey through critical illness and hospice care is chronicled in The Best Care Possible, I have witnessed and experienced how an informed and caring medical team can positively effect not only the patient, but those who love her as well. Let the publication of this book awaken us all to the need for a national discussion, in a sane and rational way, of the need of advanced directives, and an assessment of how we choose to spend our final days. Sanford E Glikin, MD
24 von 24 Kunden fanden die folgende Rezension hilfreich
5.0 von 5 Sternen A "good death?"... 31. März 2012
Von Jill Meyer - Veröffentlicht auf
Format:Gebundene Ausgabe|Von Amazon bestätigter Kauf
Dr Ira Byock's new book, "The Best Care Possible" is one doctor's look at the inevitability we all face - death. Like taxes, death is a by-product of life and a "good death", while seemingly an oxymoron, is something Dr Byock has been writing about for many years. An "end-of-life" specialist at New Hampshire's Dartmouth-Hitchcock Medical Center, Ira Byock works with a team to put together as good and gentle a death experience as possible for his patients.

Byock writes, that as we baby-boomers age, we're facing both the inevitable deaths of two generations - our parents, and then, in our turn, ourselves. As overall medical treatments advance, we're living longer and what used to kill us at earlier ages, doesn't do that so much anymore. And we're not dying as often in a family-setting. Most deaths occur in hospitals and nursing homes, with the dying tied up to machines that often keep them alive far past the point most people want to be kept alive. The old conundrum of "quality of life" vs "quantity of life".

Dr Byock's book is not a "how-to" guide to making a "good death". There are no steps he advises taking, but rather he speaks to the larger issue, from both a medical standpoint and a personal one. As a doctor in a smallish community, Byock often has to look at both views when treating his patients. He writes about teaching medical students at Dartmouth Medical School to be aware of the responsibilities as future doctors when medical treatments fail at arresting illness and the patient moves on toward death. And when advanced chemo might be granting a cancer patient a somewhat longer life span but at the cost of agonising side effects. When does a "good life" sequence into a "good death"? How does the doctor, his or her support staff, and the patient's family and friends make that "good death" occur? He's a long-time believer in hospice.

I think Dr Byock has written a few books on the subject of dying. This is the first one I've read, but not the last one. He asks questions of the reader in subtle ways that make the reader look past the often first and easy answers, to the tougher ones. But those are the answers that need to be thought about in end-of-life issues.
24 von 24 Kunden fanden die folgende Rezension hilfreich
5.0 von 5 Sternen Just What the Doctor Ordered for US Health Care 24. März 2012
Von Patrick Clary, MD - Veröffentlicht auf
Format:Gebundene Ausgabe
I wish I could send a copy of this to my mother, an RN who loved Dr. Byock's work and died 6 years ago... This book has changed the way I think about hospice and palliative medicine, not a minor accomplishment as I have been practicing this subspecialty since 1988, before it officially even existed.

Dr. Byock's earlier book "Dying Well" was a revelation to me because it held up a mirror, convinced me of the terrific potential of the work I had just begun doing and let me share that with others; "The Best Care Possible" holds such a mirror up to the whole country, showing us as a nation where we are failing to provide the care needed by the seriously ill, and how we can transform that, not only to benefit the suffering but to change the system.

Patrick Clary, MD
Exeter, New Hampshire
12 von 12 Kunden fanden die folgende Rezension hilfreich
5.0 von 5 Sternen Important book for everyone 16. Juni 2012
Von Laurie A. Brown - Veröffentlicht auf
Format:Gebundene Ausgabe
Dr. Byock is the head of the department of palliative care at Dartmouth-Hitchcock Medical Center and a professor at the associated medical school. This means he has dealt with a lot of patients who are reaching the end of their lives; his job is to make that end as comfortable and stress free as possible for both them and their families. It is his contention that Americans today suffer more and die worse deaths- and more expensive deaths- than ever before. How is this possible in an age when there are so many medical treatments available?

Part of it is that the patients don't make their wishes known via advance directives. If a person comes into a hospital without one, and they are unable to make their wishes known, the hospital has the right and obligation to do everything they can to prolong life. While this is absolutely the right thing to do most of the time, it isn't always what the person really wants. When a person is near death from cancer, say, and takes a fall that creates a brain bleed, the hospital will put them on life support and prolong their life, even if there is no chance of recovery. Would that person have wanted that, or would they prefer to let go at that point? Who wants to live another 2 weeks if they are intubated, on a ventilator and semi-conscious at best? But doctors have an obligation to preserve life, and the family feels guilty if they say `pull the plug'.

Add to this problem the fact that doctors get almost no training in palliative care and end of life issues. Many don't know the best ways to deal with pain and fear, or even how to broach the subject of impending death. Some even hesitate to prescribe opiates because they are addictive- as if that could possibly be an issue for a dying person. These things need to be addressed in medical school. Medicare adds to the problem by not paying for palliative care or hospice care if the patient is still being treated for their health problem; I know from experience that some of these treatments should NOT be considered as trying to cure the patient but rather offering a better quality to their remaining life.

This book achieved what I would have thought impossible: it's both very difficult to read, because the subject matter is emotional and painful for someone who has dealt with end of life issues, but easy to read because of Dr. Byock's talent with words. He includes medical details but at a level that is understandable to all; he includes details about death that don't gross a sensitive person out. I hope that this book gets very widely read by both doctors and lay people; having gone through five deaths in our families it would have been much easier on us as family and on the patients if we'd known a lot of what is in this book way ahead of time- and if the doctors had been more comfortable dealing with end of life.
9 von 9 Kunden fanden die folgende Rezension hilfreich
5.0 von 5 Sternen Making a case for love in healthcare 23. April 2012
Von Tarris Rosell - Veröffentlicht auf
Format:Gebundene Ausgabe
The Best Care Possible: A Physician's Quest to Transform Care Through the End of Life

There is a first time for everything, inclusive of posting comments to Amazon. Despite many years of online buying and hundreds of purchases, I admit to not having left a comment--until now. It's about time. Dr. Byock is compelling.

I literally know of no colleague in the field of bioethics who would admit to not having read Ira Byock's first book, Dying Well. It already has become a classic in our field. Dr. Byock's third book may well become another of that sort. He writes that well.

Who among us doesn't long for "the best care possible" when in need of health care for ourselves and those we love? The medical students and residents I teach and providers for whom I consult all strive for excellence in that regard. Why then does it elude us as a society? Why do so many of our elders and children still slip through the cracks of a notoriously expensive healthcare system with some of the best facilities and resources in the world? It is something of an enigma. Ira Byock is one of few people I know who can take this on with integrity and intelligence, grounded in decades of hands on, in the trenches, clinical experience.

We all have read and heard enough nonsense during recent years of highly politicized "healthcare reform" debates. It is refreshing then to read something provocative that also makes good sense. Byock tells a good story, of course. "Masterful" is the adjective that comes to mind. But this book is more than gripping narrative. It is an insightful ethics analysis and a rational policy proposal. In the end, what it boils down to, is . . . love. Dr. Byock makes a non-religious moral case for teaching, practicing, and affirming love in healthcare.

"Love is, after all, the primal impetus and sustaining force of all the caring professions. There is nothing unethical or unseemly about loving our patients" (p. 284). The preacher in me (or is it the patient?) wants to shout, "Amen!"

"Love is not all we need--science, technology, good judgment, and sound policy are also required--but without love we are without hope of fixing this crisis" (p. 285). To which the ethicist in me also says, "Amen."

Tarris Rosell, PhD, DMin
Center for Practical Bioethics
Kansas City, MO
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